Delayed maximal response to left cardiac sympathectomy for catecholaminergic polymorphic ventricular tachycardia

A 22-year-old man with multiple defibrillator shocks for catecholaminergic polymorphic ventricular tachycardia (CPVT) refractory to medical therapy underwent thoracoscopic left cardiac sympathectomy (LCS). Serial follow-up exercise tests showed delayed response with complete arrhythmia suppression and markedly improved exercise tolerance 3 months after the procedure. Left cardiac sympathectomy is a minimally invasive procedure that can reduce recurrent CPVT. The maximal effect of LCS may be delayed suggesting remodelling of cardiac sympathetic innervation.